As some of you may know, this is the second time I’ve done the stage 1 fluids and purée diet challenge (last time it was for a full week for stroke awareness)..a glutton for purée punishment perhaps!..but for me it was important to get a taste (quite literally!) of what my patients experience when a Speech and Language Therapist like myself comes along and recommends modified fluids and/or diet, so I was happy to take on the challenge once again – this time for EU Swallowing Awareness Day 2017.
When it came to my turn to do this it was the last day of the challenge (a Friday!) and that definitely brought challenges with it! By Friday I am usually well and truly knackered and food preparation has gone right out the window and I usually end up buying my lunch from the hospital canteen! Not an option this week unfortunately…
So here was my menu for the day:
Breakfast: Smooth Ready Brek with puréed pears, a stage 1 cup of tea and kefir.
Lunch: Chantenay carrot and honey roast parsnip thick soup (thickened up slightly with instant mashed potato flakes) and natural yoghurt with puréed pears.
Snack: A chocolate custard (just like the ones we spend most of our day assessing our patients swallows with!!).
Dinner: Puréed gluten free wholegrain rice and vegetarian chilli con carne. Followed by dessert of puréed strawberry cheesecake and puréed pears (again!).
– Stage 1 tea and coffee
– Stage 1 elderflower cordial
– Strawberry and banana smoothie
Breakfast was fairly easy and normal, although I did find myself leaving for work much later than usual due to all the preparation time my puréed breakfast and my morning cuppa took. In my rush to make my cup of tea I also may have added a tad too much thickener and quickly ended up with more of a stage 2/3 viscosity. Not a great start. I also missed my usual Costa Coffee Friday treat..I could have bought and thickened one up, but I imagined it would be a let down so didn’t bother.
Lunch was also relatively easy and the soup and yoghurt with puréed pears is not too dissimilar to what I would normally eat. I missed the bread though and I think that’s been a running theme with the rest of my work colleagues this week..bread really is the best thing ever and the main thing I would miss on this diet.
I did find I got hungry again quite quickly and by 5.30pm I was ready for a snack..not an easy thing to find on this diet unless you find yoghurts a satisfying snack. I made do with a chocolate custard- not something I would normally eat.
Dinner was the worst meal of the day for me on this challenge, which was sad as dinner is usually the meal I enjoy most. It tasted nice, but I found I got full quickly, as I had less work to do at the oral stage and I got sick of the same puréed texture and taste. I will admit my puréed rice was NOT a success and as it cooled it became more and more congealed and difficult to swallow. It also lacked flavour. I had had high hopes that gluten free rice may work better than normal rice which I had previously found to be very glutinous once puréed (same as pasta), but sadly not the case. Not something I’ll be recommending to my patients on puréed diet. Dessert saved the day though and was the sugar high I needed after a disappointing dinner!
So here are some of the key things that really stood out for me when I was carrying out this challenge and what I learned from doing it:
– Preparation, preparation, preparation!:
When eating puréed food you definitely get a sense of the immense preparation that goes into trying to prepare a nourishing and appetising puréed meal and also the feeling of disappointment when the meal you spent ages preparing turns out to not be quite as tasty as you had hoped and you end up binning half of it! This made me realise the value of companies such as Wiltshire Farm Foods and Oakhouse Foods where puréed meals can be ordered in and stored in the freezer. Possibly a good back up for when you haven’t got the time to prepare a meal yourself. Also I imagine that for some of our patients who may not be in good health, pureeing meals may be even more challenging.
I am really terrible for consuming fluid at the best of times and probably drink about 2 cups of tea a day in total, so long-term I would probably end up quite dehydrated on thickened fluids. For me smoothies were my salvation when I did this challenge for a week and helped me to keep hydrated, as I became so sick of the thickener which I found left a slimy coating in my mouth and sat heavy in my stomach. I think this really brings to light the real balancing act that we all need to consider for patients- the risk of aspiration vs. dehydration..not easy risks to weigh up I know, but very real as we see many patients admitted to hospital with dehydration, UTIs etc etc. So easy to reach for the thickener, but is it really always in the best interest of the patient?
Pre-challenge I had wondered how eating pureed food would challenge me nutritionally. I really enjoyed my puréed breakfast (a novelty for me as I rarely eat breakfast!), my lunch (a pretty normal lunch for me) and my snacks, but REALLY struggled with my puréed dinner and ended up leaving half of it. Over time I could certainly see myself losing my appetite for food and losing weight. It highlighted for me how at risk of malnutrition our patients on puréed diet are and the role for Dietetic support with this.
Carrying this challenge out on a Friday..the start of my weekend..was hard. My partner and I will often go out for a meal or drinks on a Friday night and it’s our opportunity to have time together, relax and get ready for the weekend ahead. Instead we stayed in, prepared separate meals and ate our dinners at different times, as his dinner was ready whilst I was still grappling with the blender! It makes me wonder how our patients deal with these challenges and how this impacts on their mood and relationships with family and friends. I know that when I did this challenge for a week I began to feel more and more low in mood as the week progressed, especially when the weekend hit and I would normally be going out for coffee and food in a cafe or restaurant with friends. I can see how fluid and diet modification could easily lead to social isolation and impact on your relationships. I feel this is something we really need to acknowledge more when working with our patients and discuss this more openly perhaps?
This experience has been such a valuable one. It challenged my clinical practice in a very positive way and hopefully has made me a better therapist for it. Firstly I must say I now have an incredible amount of respect and admiration for people who live with modified fluids and diet on a daily basis. I recognise even more now the importance of supporting patients with this and ensuring I help to prepare them for what may initially be a real challenge, but what hopefully will be made easier with support, time and help to adjust to changes in eating and drinking. I also now have a better understanding of some of the reasons why some of our patients don’t always stick with SLT recommendations..quality of life and a love of normal food and drink often wins. Hopefully as a team we can reflect on all of our experiences and think about how we can use this experience to support our patients better with their own challenge. Finally I would invite others to try this challenge – even 1 day can give you a real insight into what our patients on modified fluids and diet experience on a daily basis and certainly gives you a new appreciation of how lucky most of us are to be able to eat and drink normally and safely.